Perhaps the most common piece of information heard about depression today is that it is a disease. "Depression is a disease" is practically a mantra, used to encourage those feeling depressed to consult health professionals. In Manufacturing Depression, Gary Greenberg explores what it would mean for depression to be a disease and how we have come to view it as one. It's a nice idea for a book, but Greenberg's execution of that idea is uneven.
The book is really three separate stories: a history of ideas about the nature, causes, and treatment of depression; a recounting of Greenberg's personal experiences with depression; and a critique of the disease model of depression. The primary story, the historical one, is surprisingly haphazard. Famous thinkers who I expected to see extensive discussion of (e.g., Robert Burton, Melanie Klein, Martin Seligman) are covered either very briefly or not at all. Meanwhile, Greenberg squanders valuable space on tangential information, such as the development of statistical significance tests in agriculture, or Albert Hoffman's discovery of LSD. The problem isn't so much that Greenberg mentions these tidbits, but that he discusses them in such detail that the flow of the core story is lost. In chapter 3, for instance, Greenberg describes the derivation of dyes from sea snails, the development of chemistry in 19th century England, and the origins of the germ theory of disease, although any connections to the depression story are vague and indirect. Occasionally, his departures from the expected historical narrative are interesting (such as his consideration of the Book of Job as a story of depression and its attempted treatment), but they are more often frustrating. His coverage of typical topics (e.g., Kraepelin, Freud, the DSM) is accurate, but marred by his speculative connections between theorists' biographical details and their ideas.
The personal story, which bookends most of the chapters, involves Greenberg's multiple bouts of clinical depression, his participation in a research study aiming to treat depression, and his experiences as a psychotherapist treating clients with depression. Greenberg's descriptions of his own symptoms, his response to treatments (and its monitoring by researchers), and his approach to patients are all interesting. I often found myself wishing for more details and a more systematic presentation of these experiences. Unfortunately, this aspect of the book was short on details and long on meditative reflection that rarely led anywhere.
Finally, we come to Greenberg's critique. If Manufacturing Depression has a thesis, it is that biological/scientific approaches to understanding depression have been manufactured on the basis of thin evidence and unwarranted assumptions. Although Greenberg does not explicitly argue for this claim (his writing style is far too unsystematic for that, and his occasional arguments are actually based on rather tendentious interpretations of the relevant literatures), the book as a whole provides some evidence for the claim. Greenberg's personal experiences with depression (both as a client as a therapist) are meant to illustrate the complexity of depressive symptoms and their origins, and the intractability of finding a simple explanation for depression. His historical sketches are meant to show the wishful thinking and erroneous reasoning of those researchers and theorists who would be so bold as to think that they have explained depression once and for all. While the case is underargued, it contains a valuable lesson nonetheless: despite thousands of scientific studies on depression, we still do not have any explanations which apply to every case, let alone an explanation that leads to a treatment with anything close to guaranteed efficacy.
Unfortunately, that lesson is all that has been established after over 300 pages of Manufacturing Depression. All of Greenberg's other thoughts about depression are just intuitions without any kind of evidence or logical defense; as he admits, "All I really have is belief." He goes on to speculate that "maybe I don't want to believe that depression is a disease because I am a coward, afraid of a not-so-distant future when doctors know more about me than I possibly can, including how to make me better" (336-7). Ultimately, Greenberg's selective history and recollection of his personal experiences are designed to help him maintain a belief that he admits is merely that – a belief. Readers who already share this belief (that depression is not a disease) may find the book similarly helpful, but those expecting a neutral, representative history of ideas about depression, or a careful, systematic analysis of any of those ideas, will be disappointed.
© 2010 Benjamin J. Lovett
Benjamin J. Lovett, Ph.D., is an assistant professor of psychology at Elmira College, where his research focuses on psychoeducational assessment and psychiatric diagnosis, and he teaches a variety of courses in applied psychology.